Unit 5 Anti-coagulant Therapy. Due 6-7-23. 1000w. 4 references.

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Unit 5 Anti-coagulant Therapy. Due 6-7-23. 1000w. 4 references.

Scenario

A 77-year-old white male comes into your office complaining of feeling dizzy, short of breath, easily fatigued and having a sensation of his heart ‘skipping beats’. 

· He reports he has had these same symptoms numerous times over the last year or so, but they only lasted for about a day. 

· He thought since he has been experiencing them now for about 3 days he should come in and get checked out.

· He was diagnosed with type 2 diabetes twenty years ago and hypertension fifteen years ago.

· Current medications include Lisinopril 20 mg daily and Metformin 1000 mg daily.

· BP 172/100, P 123 irregularly irregular, R 20

· Skin is warm, pale with a slight gray cast; lungs are clear to auscultation; heart irregular rhythm

Please develop a discussion that responds to each of the following prompts.  Where appropriate your discussion needs to be supported by scholarly resources.  Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.

Initial Post

Utilize the information provided in the scenario to create your discussion post. 

1. Construct your response as an abbreviated SOAP note (
Subjective 
Objective 
Assessment 
Plan).

2. Structure your ‘P’ in the following format: [NOTE:  if any of the 3 categories is not applicable to your plan please use the ‘heading’ and after the ‘:’ input N/A]

3.
Therapeutics: pharmacologic interventions, if any – new or revisions to existing; include considerations for OTC agents (pharmacologic and non-pharmacologic/alternative); [optional – any other therapies in lieu of pharmacologic intervention]

4.
Educational: health information clients need to address their presenting problem(s); health information in support of any of the ‘therapeutics’ identified above; information about follow-up care where appropriate; provision of anticipatory guidance and counseling during the context of the office visit

5.
Consultation/Collaboration: if appropriate – collaborative ‘Advanced Care Planning’ with the patient/patient’s care giver; if appropriate -placing the patient in a Transitional Care Model for appropriate pharmacologic and non-pharmacologic care; if appropriate – consult with or referral to another provider while the patient is still in the office; Identification of any future referral you would consider making

6. Support the interventions outlined in your ‘P’ with scholarly resources.

7. What role does Anti-coagulant Therapy play among groups such as the patient in the study?

8. Summarize a scholarly article that pertains to the case study and provide feedback.

Please be sure to validate your opinions and ideas with citations and references in APA format.

Unit 5 – Anti-Coagulant Therapy

Chief Complaint- Dizziness, SOB, Fatigue, Palpitations

HPI- Patient reports feeling dizzy, short of breath, easily fatigued, and the sensation of his heart

skipping beats. Symptoms have been occurring numerous times over the past year, but they only

last for about a day. His symptoms now have persisted for 3 days.

PMH

Type 2 DM (2001)

Hypertension (2006)

Allergies-Unknown

Medications

Lisinopril 20mg PO daily

Metformin 1000mg PO daily

Social History- Unknown

Family History-Unknown

ROS:

General: Complaints of fatigue

HEENT: Reports dizziness

Cardiac: Reports sensation of heart skipping beats

Resp: Reports shortness of breath

Physical Exam:

General: 77 yo Caucasian male with acute complaints

VS: BP 172/100, HR 123 and irregularly irregular, RR 20

Skin: Warm, pale with slight gray cast

Cardiac: Heart irregular rhythm

Resp: Lungs clear

Labs/Diagnostics N/A

Assessment

1. I48.91 – Unspecified Atrial Fibrillation

 Predisposing Factors: Age- increased occurrence after age 65, history of hypertension

and diabetes (Cash & Glass, 2018).

 Complaints persistent with symptoms of atrial fibrillation: palpitations, fatigue,

dyspnea at rest or on exertion, dizziness. Patient also experiencing pallor, irregularly

irregular heart rhythm with a rate of 123 (Cash & Glass, 2018).

Plan

Diagnostics Recommendations per (
Family Practice Guidelines, 2018).

 EKG

 CBC, BMP (including electrolytes, blood glucose, BUN, Cr), magnesium, CrCl,

LFTs, Thyroid, liver, and lipid profile, BNP and NT-proBNP, PT, INR, aPTT

 Cardiac Profile (including troponin, CPK, CK-MB)

 Chest x-ray and 2-D echocardiogram

 Exercise stress test or thallium stress test, if exercise induced arrthymia or CAD is

suspected

 Holter monitoring

 Evaluation of sleep apnea (Cash & Glass, 2018).

Therapeutics Recommendations per (
Family Practice Guidelines, 2018).

 Anticoagulant therapy: (Coumadin, Pradaxa, Xarelto, Eliquis, Savaysa) Dose based on

CrCl and INR for coumadin

 Antiplatelet therapy: Asprin 81mg or Plavix 75mg daily.

 (Combined anticoagulant and antiplatelet therapies are commonly used to prevent

complications when two or more of the conditions are present: AF, mechanical valve

prosthesis, and drug-eluting stents).

 Heart rate control: Beta Blocker if not contraindicated (Atenolol, Metoprolol, or

Propranolol) Calcium Channel Blockers (Diltiazem or Verapamil)

 Heart Rhythm control: Sodium channel blockers (Disopyramide or Quinidine) or

Potassium channel blockers (Amiodarone, Dofetilide, Dronedarone, or Sotalol)

 Surgical Intervention: Ablation for recurrent AF (Cash & Glass, 2018).

Education Recommendations per (
Family Practice Guidelines, 2018).

 Encourage weight loss, smoking cessation, and stress management if indicated

 Importance of controlling other chronic medication conditions such as HTN and GM

 Counsel patient on proper nutrition (low-fat, low-cholesterol, low-sodium diet)

 CrCl is needed for patients on Pradaxa and Xarelto

 INR is needed for patients on Coumadin

 If prescribed Coumadin, you will be given a list of foods that are high in vitamin K.

 Bleeding risks associated with the use of anti-coagulation and anti-platelet therapies

 Follow-up with your primary care provider and cardiologist on a regularly scheduled

basis (Cash & Glass, 2018).

Consultation/Collaboration Recommendations per (
Family Practice Guidelines, 2018).

 Refer patient for immediate hospitalization to initiate thrombolytic therapy,

cardioversion, hypertensive management, and/or additional diagnostic testing due to

acute onset and symptomatic presentation

 Refer to Cardiology for symptomatic, new onset AFib with RVR

 Follow-up is determined by the patient’s needs, interventions performed, frequency of AF

reoccurrence, and presence of other medical conditions (Cash & Glass, 2018).

References

Cash, J., & Glass, C. (2018).
Family Practice Guidelines. 4th ed. Springer Publishing. (Version

6.8.4625)

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